Clavicle fracture are a violation of the integrity of the clavicle. It is characterized by pain, limited movement in the arm, swelling, a change in the shape of the collarbone, shortening of the upper arm. Diagnosis is carried out by a traumatologist on the basis of complaints, anamnesis, results of external examination and radiography data. In case of a fracture of the “green branch” type, a soft fixing bandage is applied in children. When the fragments are displaced, a reposition is necessary, followed by fixation with a plaster cast. In case of damage or threat of damage to blood vessels and nerves, surgery is required.
S42.0 Clavicle fracture
Clavicle fracture account for up to 12% of the total number of fractures and up to 66% of fractures of the shoulder girdle bones. In 80% of cases, the damage is localized in the middle third of the clavicle, the acromial end suffers in 15%, the sternum – in 5% of cases. They occur more often in childhood and adolescence. In children, the clavicle usually breaks like a “green branch” (while preserving the integrity of the periosteum). In adults, fractures with displacement are often observed.
Clavicle fracture causes
Most often, injuries develop as a result of an accident at home or on the street. The following mechanisms are possible:
- With a direct injury (a blow to the collarbone), oblique, transverse and comminuted clavicle fracture usually occur. They are observed during fights with the use of sticks, bits and metal rods, the fall of a heavy object, a collision with a protruding part of the structure: a production mechanism, a children’s town, etc.
- With indirect trauma (falling on an outstretched arm, elbow or shoulder), oblique and oblique fractures are formed. The cause of the fall is usually unfavorable weather conditions, less often alcohol or drug intoxication.
- In some cases, a fracture of the collarbone is provoked by a sharp contraction of the muscles. Such injuries can be detected after a generalized epileptic seizure.
The clavicle is a small, slightly curved tubular bone located above the upper rib and connecting the sternum with the shoulder blade. It serves to strengthen the shoulder girdle, is a support for the shoulder blade and bones of the upper limb. Protects nerves and large vessels of the axillary region.
The localization of the fracture is largely determined by the anatomical features of the bone. Most often, the clavicle breaks in the middle third closer to the acromial end – in the thinnest and most curved part. Other factors affecting the location of the injury are the direction and point of application of the traumatic force.
The most common are comminuted and oblique fractures. Under the influence of muscle traction and limb weight, the peripheral fragment of the clavicle shifts downward, inward and anteriorly. At the same time, the sternoclavicular muscle “pulls” the central fragment down and back. As a result, the upper arm is shortened. Sometimes the end of the peripheral fragment moves into the area of the neurovascular bundle, this is dangerous due to the threat of nerve damage and bleeding.
In modern traumatology and orthopedics , the systematization of clavicle fractures is used , taking into account several factors:
- by localization: damage to the outer, middle and inner third of the clavicle;
- by the nature of the fragments: transverse, oblique, oblique, comminuted and S-shaped;
- by type of injury: open and closed fractures.
Possible injuries to the clavicle without displacement and with displacement of fragments. Fractures with displacement may be accompanied by damage to the pleura, nearby nerves and blood vessels.
Clavicle fracture symptoms
The patient is concerned about the pain at the fracture site. Hand movements on the damage side are severely limited. The upper arm is edematous, shortened. The shape of the clavicle has been changed. The shoulder is lowered, its displacement is observed inwards and anteriorly. With a healthy hand, the patient holds the injured limb by the elbow or forearm and presses it to the trunk.
During examination, hemorrhages, pathological mobility and crepitation of clavicle fragments may be detected. With open fractures, a small wound is visible in the area of the upper arm, often with the end of the bone fragment protruding from it. If the integrity of the neurovascular bundle is violated, numbness and weakness of the limb may be detected, general weakness and dizziness due to internal bleeding are possible. Pleural rupture is accompanied by shortness of breath and lack of air due to pneumothorax.
Complications of clavicle fractures are quite rare. The most common negative consequence is injury to a vessel or nerve by a sharp bone fragment. In case of violation of the integrity of the nerves in the long-term period, disorders of sensitivity and movements of varying degrees of severity may be observed. Rupture of a large vessel is fraught with significant blood loss. Pneumothorax is rarely diagnosed, and in the absence of medical care can be life-threatening.
Diagnosis of a clavicle fracture is carried out by a traumatologist in the emergency room or outpatient admission in the emergency room. The following techniques are used:
- Objective examination. When examining the injury site, a characteristic deformation of the clavicle, swelling, pain, and sometimes crepitation of fragments is determined. During a general examination, attention is paid to the preservation of sensitivity and movements in the upper limb, the absence or presence of signs of blood loss, breathing difficulties.
- Clavicle x-ray. The fracture zone and the direction of displacement of the fragments are usually clearly visible in the images. In children, an angular deformation is detected due to the displacement of fragments while maintaining the integrity of the periosteum.
If a nerve injury is suspected, a neurologist’s consultation is required, if there are signs of a violation of the integrity of the vessels, an examination by a vascular surgeon is indicated.
Clavicle fracture treatment
Therapeutic tactics are determined by the presence and nature of displacement. Children and adults with uncomplicated, well-reponsible clavicle fracture without the threat of damage to nerve trunks or vessels do not need inpatient treatment. With the threat of complications, hospitalization in the traumatology department is indicated. In most cases, there is a good effectiveness of conservative treatment, operations are rarely performed.
First aid consists in hanging the limb on a kerchief bandage, bending it at the elbow joint and binding it to the body. You should not try to eliminate the displacement yourself by sudden jerks or movements of the affected limb – this can cause secondary displacement of fragments, increase the risk of complications.
The main method of treatment is immobilization. The fixation period in children is 2-3 weeks, in adults – 1 month. In childhood, Delbe rings are usually enough to hold fragments. Adults use a Chizhin frame and other special bandages.
In case of fractures of the “green branch” type and injuries without displacement, a fixing bandage is applied.
In case of a clavicle fracture with dislocation of fragments, local anesthesia is performed, followed by reposition and fixation with a soft or plaster bandage.
After the reposition, a control snapshot is taken, UHF is prescribed. With severe pain in the first days after the injury, it is recommended to take analgesics. After the immobilization is stopped, the patient is sent for massage and physical therapy.
Indications for emergency surgical treatment are all open clavicle fracture and closed injuries with the development of complications or the threat of damage to nerves, pleura and blood vessels by unstable bone fragments. Planned operations are performed with irreversible displacement of fragments and significant external deformation of the upper arm. The following variants of osteosynthesis of the clavicle are possible:
- Intraosseous. It is indicated for comminuted fractures, a special pin or a Bogdanov nail is used.
- Boneless. It is recommended for multi-splinter damage, carried out using a curved plate.
- Spokes. Fixation is performed with spokes, which are carried out through fragments of the collarbone. The ends of the spokes are taken out of the bone and fastened.
In the postoperative period, antibiotics, analgesics, physiotherapy are prescribed. The discharge is carried out after the removal of the seams (for 8-10 days).
The prognosis for uncomplicated clavicle fractures is favorable. Fragments usually fuse well even in the presence of residual displacement, the function of the upper limb is fully restored. The outcome of concomitant injuries of the pleura and neurovascular bundle is determined by the severity of the damage, the timeliness of medical care.
Prevention includes measures to reduce the level of injuries. During the period of ice, it is necessary to choose stable shoes with non-slip soles to prevent falls. Since clavicle fracture are often found in children, important preventive measures are sufficient control during the child’s stay on the street, the equipment of safe children’s play complexes.
- Ropars M, Thomazeau H, Huten D. Clavicle fractures. Orthop Traumatol Surg Res. 2017 Feb;103(1S):S53-S59. – link
- Wiesel B, Nagda S, Mehta S, Churchill R. Management of Midshaft Clavicle Fractures in Adults. J Am Acad Orthop Surg. 2018 Nov 15;26(22):e468-e476. – link
- Robinson CM. Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br. 1998 May;80(3):476-84. – link
- Hughes K, Kimpton J, Wei R, Williamson M, Yeo A, Arnander M, Gelfer Y. Clavicle fracture nonunion in the paediatric population: a systematic review of the literature. J Child Orthop. 2018 Feb 01;12(1):2-8.
- Ban I, Troelsen A. Risk profile of patients developing nonunion of the clavicle and outcome of treatment–analysis of fifty five nonunions in seven hundred and twenty nine consecutive fractures. Int Orthop. 2016 Mar;40(3):587-93. – link